Alternative medicine: from new age to mainstream.

Have all those hours spent surfing the Net resulted in sore wrists? Could you be suffering from carpal tunnel syndrome? Try a yoga-based regimen which, tested in clinical trials, shows health benefits for treatment of CTS. Looking for alternatives to your weekly shrink session? Drink a cup of St. John's Wort tea, sit back, and relax. From the use of acupuncture for smoking cessation and other addictive behaviors to the use of saw palmetto extracts for the treatment of benign prostatic hyperplasia, alternative medicine is growing in popularity.

Alternative medicine, once considered a new age approach to holistic health, is rapidly becoming a mainstream choice in American health care. During the 1990s, health care consumers - both nationally and in Montana - have been using nontraditional, alternative medicine modalities such as chiropractic services, acupuncture, herbal remedies, spiritual healing, exercise, and diet at higher rates than ever before.

In the last issue of the Montana Business Quarterly, Marc Micozzi, a physician and keynote speaker at the 1998 Mansfield Conference on alternative medicine, looked at how federal regulations might impact this growing industry. In conjunction with the Mansfield Conference, the Bureau of Business and Economic Research conducted a survey of alternative medicine use in Montana. This article reports some of the findings.

According to the Bureau's Montana Poll, conducted in fall 1998, 59 percent of Montanans reported using some form of alternative medicine. This figure is high compared to the 40 percent national utilization rate reported in other studies (Astin, 1998).

The widespread use of alternative medicine reflects both social norms and medical trends. Freedom of choice and personal control in health care decisions is motivating people to use alternative therapies. The medical community's gradual acceptance and scientific validation of some alternative medicine practices has encouraged more physicians to seriously consider nontraditional, alternative methods as healing options for their patients.

Practitioners view the "coming out" of alternative medicine as a mixed blessing. Increased demand and more consumer spending strengthens the economic base for alternative therapies. However, over-commercialization and co-option of the holistic spirit concern alternative therapy providers as different modalities become more fully integrated with conventional health insurance plans. The mainstream institutionalization of alternative medicine is seen by some as a threat to the personal relation between provider and patient, a synergistic healing relationship that may be subverted by cost containment values.

Conventional medicine's prerequisite of scientific validation of health benefits portends a fundamental clash of cultures between traditional and alternative medicine. Whether conventional medicine's religious belief in scientific rationalism can coexist with the more broadly based, philosophical and spiritual beliefs of alternative medicine remains to be seen. What is certain is the dramatic rise in the utilization of alternative medical therapies by American health care consumers.

The Market For Alternative Medicine

The Bureau's Montana Poll, a statewide telephone survey of a randomly selected, representative sample of 398 Montana adults, asked questions about the use of 16 different alternative modalities within the past year. Respondents were also queried on alternative medicine use in relation to health problems, conventional medicine use, their education and income, and a number of demographic characteristics. The survey data provide a robust picture of the alternative medicine market in Montana and its relation to national trends.

Montana's alternative medicine consumers are highly educated, with one-third of the poll's respondents reporting a college degree and one-half reporting household income of more than $35,000. Alternative medicine use is more common among women (59 percent) than men (41 percent). No one age group dominates alternative medicine use in Montana, with consumers equally distributed over the ages 35 to 49, 50 to 64, and 64 and older. Furthermore, there doesn't appear to be any regional concentration of alternative medicine use in the state. About 38 percent of alternative medicine consumers live in Eastern Montana and another 38 percent live in Western Montana. The remaining 24 percent live in the North Central region around Great Falls.

Montanans who used alternative medicine rated their health status as good to excellent, with only 10 percent indicating fair or poor health. This high end rating of self-reported health status was similar to the 41 percent of people polled who did not use alternative medicine. Therefore, health status does not seem to affect the demand for alternative medicine.

In order to avoid an overcount of alternative medicine users, those indicating the use of exercise or diet for heart and circulatory-related health problems were moved out of the sample; physicians now consider these activities standard treatment. This adjustment means that the 59 percent estimate of Montanans who use alternative medicine is a fairly conservative estimate.

As shown in Figure 1, the most frequently used alternative modalities among Montana respondents were exercise/movement therapy (40 percent), chiropractic services (22 percent), herbal therapies (19 percent), and lifestyle/diet (16 percent). Montana's top four most frequently used modalities mirrored national patterns, with the exception of Montana's higher use of herbal remedies compared to a more frequent use of relaxation techniques nationally. The fifth and six place ranking of spiritual healing and megavitamins in Montana corresponded closely with the national sample (Eisenberg, 1998).

Massage therapy was used more frequently than relaxation therapies in Montana. Homeopathy, a natural healing process of treating an illness with a substance or medicine that produces mild symptoms associated with the illness, was used by 8 percent of the respondents. The comparatively lower utilization rate of homeopathy in Montana was similar to that modality's low utilization rate reported in national surveys.

Alternative Therapies For Specific Health Problems

Chronic pain, anxiety, fatigue, and sprains/strains were the most common health problems addressed by consumers of alternative medicine, the Montana Poll found. Table 1 lists the most frequently used alternative therapies for specific health problems and the number of respondents indicating the use of that treatment for the specific problem.

Chiropractic services and exercise/movement therapies were used most frequently for chronic pain and sprains/strains, including lower back problems. Massage therapy was used mostly for treating sprains and strains.

Montanans used herbal therapy for chronic pain more frequently than residents of other states. Spiritual healing for fatigue and severe headaches was also more common in Montana, as was the use of relaxation techniques for addictive problems. Generally, the use of herbal therapies and spiritual healing for specific health problems was used much more often in Montana compared to the rest of the nation.

Another standout from the national pattern was Montana's use of homeopathy, herbal medications, and exercise for digestive problems in contrast to a national reliance on lifestyle, diet, chiropractic services, and relaxation.

Alternative therapies for specific health problems are sometimes used in conjunction with a physician and conventional medicine, the Montana Poll found. Respondents were queried on their use of alternative therapies with conventional medicine and whether their physician was aware of their use of alternative medicine.

About 20 percent of the Montana health care consumers who used relaxation techniques, massage therapy, or spiritual healing reported using these alternatives in conjunction with conventional medicine. For the most part, though, physicians were not aware of their patients' alternative therapies.

Insurance Coverage

National expenditures on alternative medicine are estimated to be about $27 billion and growing at more than 15 percent per year, with more than three-fourths of the cost paid out of pocket by consumers (Rauber, 1998). This means that consumers are footing the bill for having some degree of control and freedom of choice over their use of alternative medicine. A number of health insurers throughout the country are responding to these consumer preferences by incorporating alternative medicine benefits into their plans.

A little more than half of Montanans using alternative medicine reported having health insurance coverage. In Montana, only one insurer, Blue Cross Blue Shield, covers both chiropractic and acupuncture treatments. Other alternative therapies - including herbal therapy, homeopathy, or massage therapy - are not currently covered by health insurance plans in Montana.

Outside of Montana, health plans such as Blue Shield of California and the Connecticut-based Oxford Health Plan are offering limited alternative medicine coverage to their customers. Integrating alternative medicine into conventional health plans is motivated by consumer demand, as well as by potential cost savings offered by alternative medicine over conventional treatments.

The role of physicians in the alternative medicine movement is still very much ill-defined. An estimated 90 percent of patients using alternative medical care do not go through their physicians and are self-referred. Low levels of physician involvement are partly due to a lack of scientific evidence and credibility for many alternative therapies; however, this is changing. The National Institutes of Health have established an Office of Alternative Medicine (OAM). Although OAM is sparsely funded, it is initiating more rigorous testing of alternative therapies. The conventional medical establishment, most notably in the form of the Journal of the American Medical Association, is now publishing reports from random controlled tests of alternative therapies.

Table 1

Most Frequently Used Alternative Therapies for Specific Health
Problems

                            Most Frequently Used Alternatives
Health Problems                   (No. of Respondents)

Chronic Pain                       Chiropractic (60)
                                    Exercise (58)
                                  Herbal Medicines (20)

Anxiety                             Exercise (36)
                                   Relaxation (23)
                                  Herbal Medicines (22)

Fatigue                           Spiritual Healing (12)
                                    Relaxation (12)
                                     Exercise (10)

Sprains & Strains                    Exercise (63)
                                   Chiropractic (52)
                                      Massage (20)

Addictive Problems                Spiritual Healing (4)
                                     Relaxation (3)
                                   Herbal Medicines (2)
                                      Exercise (2)

Arthritis                             Exercise (35)
                                    Chiropractic (15)
                                   Herbal Medicines (3)

Severe Headaches                     Chiropractic (21)
                                      Relaxation (12)
                                   Spiritual Healing (11)

Depression                             Exercise (19)
                                   Herbal Medicines (13)
                                   Spiritual Healing (13)

Digestive                           Herbal Medicines (18)
                                        Exercise (10)
                                        Homeopathy (9)

Diabetes                                Lifestyle (13)
                                         Exercise (10)
                                     Spiritual Healing (4)

Source: Montana Poll, Fall 1998, Bureau of Business and Economic
Research, The University of Montana-Missoula.

Commercialization of Alternative Medicine

The increasing popularity of alternative medicine is forcing hospitals, physicians, and other health providers to take notice. Hospitals in Colorado, Indiana, and other parts of the nation are either considering or actually moving forward on building integrative clinics based on an alternative, complementary medicine and conventional medicine model. Medical researchers are subjecting more alternative therapies to random controlled clinical trials in order to identify their health benefits.

Some practitioners of alternative modalities fear that too much integration of alternative medicine into conventional medical treatments may dilute the holistic, spiritual origins of their art of healing. Alternative medicine providers see themselves as providing understanding for their patients, along with meaning and self-care methods for managing their condition. Patient participation in the healing process and personal attention are two hallmarks of alternative medicine that may suffer at the hands of commercialization.

Historically, alternative medicine has attracted both providers and consumers interested in a more subjective, personalized, and spiritual approach to medicine and healing. And while connotations of new age, touchy-feely mysticism may still cloud some people's opinion, alternative therapies are being used with either perceived or real health benefits by an increasing number of health care consumers in Montana and throughout the country.

References

Astin, John A. "Why Patients Use Alternative Medicine," Journal of American Medical Association, vol. 279, no. 19 (May 20, 1998), pp. 1548-1553.

Eisenberg, David M. "Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey," Journal of American Medical Association, vol. 280, no. 18 (November 11, 1998), pp. 1569-1575.

Greenwald, John "Herbal Healing," Time, November 23, 1998.

Rauber, Chris. "Open to Alternatives," Modern Healthcare, September 7, 1998.

Steve Seninger is director of the Bureau's Health Care Industry Research Program.